1. Advanced Neuro-Care
Institute

2. Spine- care
Dr Manish Vaish
DNB (Neurosurgery)
Fellow of American Association of Neurological Surgeons
Member AO spine Society
Senior Consultant MAX Healthcare and GBH-American Hospital

3. A little bit of ANATOMY

4. The Spinal Column

5. Low Back Pain
 Second most
common cause of
missed work days
 Leading cause of
disability between ages
of 19-45
 Number one
impairment in
occupational injuries

6. Low Back Pain
 Most episodes of LBP are
self limited
 These episodes become
frequent with age
 LBP is usually due to
repeated stress on the
lumbar spine over many
years (“degeneration”),
although an acute injury
may cause the initiation
of pain

7. Why it is common?
 The lumber spine has lordotic curve –Last in the
evolutionary process, though made perfect-every
spine degenerates! WHY!!!
 From four legged mammal to two legged human
being, only due to lumber curve

8. Forces Acting on the Spine
Compressive forces push
bones and discs together.
Tensile forces act (pull) on
ligaments, tendons and
muscles.
Typically these forces occur
simultaneously, for example,
when lifting objects, or when
“SLOUCHING.”

9. Back Injury Risk Factors - Acute
slips, trips and falls;
auto accidents;
sedentary lifestyle (with
occasional lifting);
heavy and/or awkward
loads;
improper lifting technique.
Acute (traumatic) back injury :

10. Back Injury Risk Factors - Chronic
Chronic back injury may result
from poor posture and/or
improper lifting technique
combined with repetitive lifting.
Additionally, genetics and
overall physical fitness may
affect spine health.

11. Maintaining a neutral spinal
posture is important when seated
as well as during lifting tasks.
If sitting without back support,
rotate the hips forward until a
neutral posture is achieved.
If using the backrest, sit back in
the chair to allow the backrest to
help maintain a neutral posture
and reduce muscle loading.
“Flat” Neutral
Back Injury Risk Factors - Chronic

12. Risk Reduction - Engineering/Design
Design a safer lifting
environment by:
avoiding very high and very low
object placement;
reducing object weight and size;
providing handles;
eliminating the need for twisting
motions;
eliminating bending and stooped
postures; and
by providing mechanical
assistance.

13. Risk Reduction - Lifting Tips
When lifting, you can substantially reduce
your risk of low back injury and pain by:
keeping the object close to you;
bending your knees;
maintaining your lumbar curve (bend
knees and stick buttocks out);
not twisting or bending sideways;
avoiding rapid, jerky movements; and
asking for assistance with heavy and/or
bulky loads.

14. Slipped Disc/ Disc Herniation

15. Disc Degeneration
 With age and repeated efforts, the lower
lumbar discs lose their height and water
content (“bone on bone”)
 Abnormal motion between the bones leads
to pain

16. Most Common Problems
 Disc herniation – leads to leg (or
arm) pain
 Disc degeneration – leads to low back
(or neck) pain

17. Risk Reduction at Home
Maintaining a neutral spinal
posture when stooped (e.g.,
when shaving, brushing teeth,
bathing children, repairing cars,
shoveling, etc.) may reduce your
risk of back injury and discomfort.
Planning your lifts, getting
assistance, and using mechanical
advantage are examples of risk
reduction strategies.

18. Back Pain - When to Seek Help
For common back sprain, give home remedies a
try for 72 hours.
In rare cases, back pain can indicate a
serious problem - seek medical attention if:
you have weakness or numbness in
either leg;
you have a fever along with back
pain;
you notice bladder or bowel control
problems;
your pain increases with lying down;
or
you have a history of significant
chronic disease, such as osteoporosis,
cancer or diabetes.

19. Diagnostic Modalities
 X-ray :
40% of the destruction of destruction occurs before it
appears on X-ray
Normal asymptomatic patient will have same changes on X
ray
 MRI:
All answers for backache
always has to read in light of patients symptoms
 CT :
Some times your surgeon might ask for it as well

20. Neck pain
 Use of pillow
 Neck roll
 Chin tuck and stretch
 Neck side tilt
 Neck turn

21. Take home message
 Know the warning signs of back pain caused by poor ergonomics and
posture
 Get up and move
 Keep the body in alignment while sitting in an office chair and while
standing
 Use posture-friendly props and ergonomic office chairs when sitting
 Increase awareness of posture and ergonomics in everyday settings
 Use exercise to help prevent injury and promote good posture
 Wear supportive footwear when standing
 Remember good posture and ergonomics when in motion
 Create ergonomic physical environments and workspaces, such as for
sitting in an office chair at a computer
 Avoid overprotecting posture.

22. THANKS
VERY MUCH

23. Disc Degeneration – MRI

24. Management
 REST IN BED
 Manipulation
 Medications
 Epidural injections
 Facet blocks
 Physiotherapy

25. Indications for Surgical Treatment
 Low back pain for at least 2 years
 Incapacitating
 Resistant to physical therapy and medication
 Positive MRI findings (degenerative changes) at L4-5
and/or L5-S1
 For selected cases:
 Concordant pain on discography
 Psychological evaluation

26. Results of Surgical Treatment
 Fritzell et al., Spine 2001 Dec 1;26(23):2521-32
 Prospective randomized multicentric study (class
I evidence)
 In the surgical group, 63% of patients rated
themselves as “much better” or “better”,
compared to 29% in the nonsurgical group
 Surgical treatment is superior to nonsurgical
therapy in a well selected group of patients

27. Management
Surgery-disc prolapse
Direct addressing pathology
 Myths
 No surgical procedure
 Permanent backache
 Loss of bladder control
 Lack of stability
 Loss of motor power
 Paralysis
 Removal of whole disc
 Longer stay in bed
 Fact
 Specific Indications for
specific surgery
 Refinement of surgical
technique-microscopic
 Preservation of the facets
and protection of dura
 Removal of disc which
has prolapsed, otherwise
intact

28. Management
Surgery-disc prolapse
 Hemi Laminectomy –
Fenestration technique
 Endoscopic discectomy –
few indication
 Thermal ablation no statistical
data
 Laser ablation Micro-ENDOscopic
discectomy – Gold
standard